Provider Demographics
NPI:1770366734
Name:GRIM, CATHERINE N (MED, MT-BC)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:N
Last Name:GRIM
Suffix:
Gender:F
Credentials:MED, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2130
Mailing Address - Country:US
Mailing Address - Phone:918-600-2525
Mailing Address - Fax:
Practice Address - Street 1:4421 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2130
Practice Address - Country:US
Practice Address - Phone:918-600-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
OK17666225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist